Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations.

Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

Chemowraps as an adjuvant to surgery for patients with diffuse squamous cell carcinoma of the extremities.

BACKGROUND: Managing patients with diffuse squamous cell carcinoma (SCC) and actinic damage on their extremities is challenging because SCCs may be ill-defined, confluent, and only amenable to radical surgery. Diffuse actinic keratoses put patients at risk for further malignancies and may be difficult to distinguish from SCCs. An experience using chemowraps, a novel approach involving weekly 5-fluorouracil (5-FU) 5% cream under Unna wraps to reduce actinic keratoses, as an adjuvant to surgery is described. METHODS: A series of 3 representative patients is presented. Before chemowraps were applied, biopsies and clinical lymph node examinations were performed to confirm the diagnosis of SCC. Patients were informed that chemowraps represent an off-label use of 5-FU to reduce actinic keratoses as an adjuvant to definitive surgery for SCCs. RESULTS: Three patients were referred for diffuse actinic damage and biopsy-proven SCCs on the legs. Patients tolerated chemowraps well (applied for 4-20 weeks) and showed reduction in clinical lesions at 6 weeks to 3 years follow-up. CONCLUSIONS: Chemowraps may be useful in managing patients with diffuse SCCs in fields of severe actinic damage on the extremities. As an adjuvant to surgery, chemowraps may treat surrounding actinic keratoses, help define tumor borders, and minimize the extent of surgery required.